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International Journal of Trend in
International Open Access Journal
ISSN No: 2456
@ IJTSRD | Available Online @ www.ijtsrd.com
Vitamin D Deficiency in Association w
Dr. Pushpamala
Dr. Lamiaa Ahmed Elsayed
1,4
Professor, 2
Associate P
3
Associate
1,2,3,4
Umm al Qura University, Makkah, Kingdom of Saudi Arabia
ABSTRACT
Vitamin D deficiency is gaining increasing attention
for its novel association with Obesity. Studies have
found that maintaining vitamin D status may reduce
ones risk of developing various diseases. Background
In 2010, overweight and obesity were estimated
cause 3•4 million deaths, 3•9% of years of life lost,
and 3•8% of disability-adjusted life-years (DALYs)
worldwide. The rise in obesity has led to widespread
calls for regular monitoring of changes in overweight
and obesity prevalence in all population
treatment of obesity and cardiovascular diseases is
one of the most difficult and important challenges
nowadays. This paper seeks to examine the
consistently reported relationship between obesity and
low vitamin D concentrations in association with
HSCRP, with reference to the possible underlying
mechanisms. The possibility that vitamin D may assist
in preventing or treating obesity is also examined and
recommendations for future research are made. We
tested the hypothesis that suggests Adults with s
obesity have lower 25-hydroxyvitamin D levels will
have higher hs-CRP levels.
Keyword: Vitamin D deficiency, High Sensitive C
Reactive Protein, Obesity.
INTRODUCTION
Vitamin D deficiency is the most common nutritional
deficiency and the very likely, the most common
medical condition in the world. There is a consistent
association in the published literature between
increasing BMI and lower serum 25-hydroxyvitamin
D (25D) concentrations. A bi-directional genetic
study, which limits confounding, has suggested that
higher BMI leads to lower 25D, with the effects of
lower 25D on BMI likely to be small
International Journal of Trend in Scientific Research and Development (IJTSRD)
International Open Access Journal | www.ijtsrd.com
ISSN No: 2456 - 6470 | Volume - 2 | Issue – 6 | Sep
www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018
Deficiency in Association with HSCRP Linked t
Pushpamala Ramaiah1
, Dr. Ayman Johargy2
,
Lamiaa Ahmed Elsayed3
, Dr. Grace Lindsey4
Professor of Medical Microbiology, Faculty of Medicine
Associate Professor at Faculty of Nursing
Umm al Qura University, Makkah, Kingdom of Saudi Arabia
Vitamin D deficiency is gaining increasing attention
for its novel association with Obesity. Studies have
found that maintaining vitamin D status may reduce
ones risk of developing various diseases. Background
In 2010, overweight and obesity were estimated to
cause 3•4 million deaths, 3•9% of years of life lost,
years (DALYs)
worldwide. The rise in obesity has led to widespread
calls for regular monitoring of changes in overweight
and obesity prevalence in all populations. The
treatment of obesity and cardiovascular diseases is
one of the most difficult and important challenges
nowadays. This paper seeks to examine the
consistently reported relationship between obesity and
low vitamin D concentrations in association with
HSCRP, with reference to the possible underlying
mechanisms. The possibility that vitamin D may assist
in preventing or treating obesity is also examined and
recommendations for future research are made. We
tested the hypothesis that suggests Adults with severe
hydroxyvitamin D levels will
Vitamin D deficiency, High Sensitive C
Vitamin D deficiency is the most common nutritional
likely, the most common
medical condition in the world. There is a consistent
association in the published literature between
hydroxyvitamin
directional genetic
has suggested that
higher BMI leads to lower 25D, with the effects of
lower 25D on BMI likely to be small[1]
. Lower
vitamin D in obese people is a consistent finding
across age, ethnicity, and geography. This may not
always reflect a clinical problem.
higher loading doses of vitamin D to achieve the same
serum 25-hydroxyvitamin D as normal weight.
His work suggests that vitamin D gets diluted
throughout the body, and that dilution shows up as a
deficiency in overweight and obese
more mass than normal-weight people. On the other
hand, a number of studies have confirmed that C
reactive protein (CRP), an inflammatory marker, is a
strong predictor of CVD Thus, it is likely feasible to
prevent CVD with the help of CRP
treatments.[ 3 ]
. Previous studies have shown
that vitamin D deficiency is associated with both
developing obesity and the risk of obesity related
complications, but studies on the effects of vitamin D
supplementation have been inconclusive. The
association between reduced 25D concentrations and
obesity is therefore well-established, although the
mechanisms for the lower 25D concentrations are not
fully described, and there is uncertainty as to what the
health consequences of these lower concentrations
might be. This paper attempts to summarize the
current state of knowledge regarding the causes of
these reduced 25D concentrations, as well as the
possible effects of vitamin D supplementation on
obesity. [4]
Background: It has been estimated that 1 billion
people worldwide have Vitamin D deficiency or
insufficiency. This is mostly attributable to people
getting less sun exposure because of climate,
and concerns about skin cancer.
association in the published literature between
increasing BMI and lower serum 25
Research and Development (IJTSRD)
www.ijtsrd.com
6 | Sep – Oct 2018
Oct 2018 Page: 792
Linked to Obesity
of Medical Microbiology, Faculty of Medicine,
Umm al Qura University, Makkah, Kingdom of Saudi Arabia
vitamin D in obese people is a consistent finding
across age, ethnicity, and geography. This may not
always reflect a clinical problem. Obese people need
higher loading doses of vitamin D to achieve the same
hydroxyvitamin D as normal weight. [ 2 ]
.
His work suggests that vitamin D gets diluted
throughout the body, and that dilution shows up as a
deficiency in overweight and obese people, who have
weight people. On the other
hand, a number of studies have confirmed that C-
reactive protein (CRP), an inflammatory marker, is a
strong predictor of CVD Thus, it is likely feasible to
prevent CVD with the help of CRP-reducing
Previous studies have shown
deficiency is associated with both
developing obesity and the risk of obesity related
omplications, but studies on the effects of vitamin D
supplementation have been inconclusive. The
association between reduced 25D concentrations and
established, although the
mechanisms for the lower 25D concentrations are not
ly described, and there is uncertainty as to what the
health consequences of these lower concentrations
might be. This paper attempts to summarize the
current state of knowledge regarding the causes of
these reduced 25D concentrations, as well as the
ble effects of vitamin D supplementation on
It has been estimated that 1 billion
people worldwide have Vitamin D deficiency or
insufficiency. This is mostly attributable to people
getting less sun exposure because of climate, lifestyle,
and concerns about skin cancer. There is a consistent
association in the published literature between
increasing BMI and lower serum 25-hydroxyvitamin
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456
@ IJTSRD | Available Online @ www.ijtsrd.com
D (25D) concentrations.[5]
. Some people get tested for
vitamin D and find, despite taking vita
regularly, that they are still not getting enough
vitamin D. This means their body is having hard time
absorbing their vitamin D supplements. The vitamin
D council recommends testing every three to six
months, if they are trying different regimens. T
vitamin D council believes that trying to get enough
vitamin D from diet is unlikely to get sufficient
vitamin D which is needed. [6]
.Recently, there has
been increased interest in the relevance for vitamin D
to human health accompanied by increase dema
vitamin D testing, which has led to the use of less
precise assays, which recommend the use of gold
standard LC-MS assay, and insist a large national
community based study of the prevalence of low
vitamin D using this method. [7]
. Al-Daggrey (2014)
pointed out that the recommended period for sun
exposure to the sun is half-an-hour, three to four days
a week. There is a clear need for adequately
prospective interventions which include baseline
measurement of 25D concentrations and CRP also
involve adequate doses of supplemental vitamin D.
Until such studies have been reported, the role of
vitamin D supplementation in obesity prevention
remains uncertain.
The aim of the study was:
 To identify the prevalence of vitamin D deficiency
and HSCRP among adults.
 To examine relationships between dietary habits
and 25-hydroxyvitamin D [25(OH)D] level.
 Investigate the associations between the 25(OH)D
concentrations and the biomarker of i
HSCRP.
 To evaluate whether vitamin D insufficiency and
increased serum high-sensitivity C
protein (hs-CRP) linked to Obesity.
Patients and Methods: Using a longitudinal, cross
sectional design, systolic and diastolic blood pressure,
dietary information, serum 25(OH) D, serum CRP,
fasting glucose and insulin, 2-h glucose from oral
glucose tolerance test, hemoglobin A1c, thyroid
profile, liver profile were recorded for 124 volunteer
subjects at an referral clinic. Data was collected
during their visit at clinic between April 2017 and
April 2018. Adults of ages between 20 to 65 years
were selected as participants, written informed
consent was obtained from the subjects from whom
data were collected prospectively. The subjects who
were on use of any medication known to effect
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456
www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018
Some people get tested for
vitamin D and find, despite taking vitamin D
regularly, that they are still not getting enough
vitamin D. This means their body is having hard time
absorbing their vitamin D supplements. The vitamin
D council recommends testing every three to six
months, if they are trying different regimens. The
vitamin D council believes that trying to get enough
vitamin D from diet is unlikely to get sufficient
.Recently, there has
been increased interest in the relevance for vitamin D
to human health accompanied by increase demand of
vitamin D testing, which has led to the use of less
precise assays, which recommend the use of gold
MS assay, and insist a large national
community based study of the prevalence of low
Daggrey (2014)
ointed out that the recommended period for sun
hour, three to four days
There is a clear need for adequately-powered,
prospective interventions which include baseline
measurement of 25D concentrations and CRP also
olve adequate doses of supplemental vitamin D.
Until such studies have been reported, the role of
vitamin D supplementation in obesity prevention
To identify the prevalence of vitamin D deficiency
To examine relationships between dietary habits
hydroxyvitamin D [25(OH)D] level.
Investigate the associations between the 25(OH)D
concentrations and the biomarker of inflammation
To evaluate whether vitamin D insufficiency and
sensitivity C-reactive
Using a longitudinal, cross-
sectional design, systolic and diastolic blood pressure,
ietary information, serum 25(OH) D, serum CRP,
h glucose from oral
glucose tolerance test, hemoglobin A1c, thyroid
profile, liver profile were recorded for 124 volunteer
subjects at an referral clinic. Data was collected
ng their visit at clinic between April 2017 and
April 2018. Adults of ages between 20 to 65 years
were selected as participants, written informed
consent was obtained from the subjects from whom
data were collected prospectively. The subjects who
se of any medication known to effect
vitamin D metabolism were excluded from the
project. Those subjects having 25 (OH) vitamins D
level > 150 ng/mL were also excluded from the study.
Institutional Review Board approved the projects.
Tools of data collection: Data was collected by
using: 1. A structured pre-
developed by King Saud University, Biomarkers
Research Department after obtaining the consent from
the author of the questionnaire. Pre
structured questionnaire was div
sections as follows: a. Socio demographic data.
Polar questions with regard to knowledge about
Vitamin D and associated diseases.
sunshine exposure and duration.
Serum analysis to find out the level of
HSCRP and other biomarker values. The
recommended, best test for assessing vitamin D status
is to measure 25(OH) D levels using a reliable assay
in population at risk for vitamin D deficiency is
Electro chemical luminescence assay.
3. Anthropometric Assessment:
was performed by the physician and the nurse. Height
and weight was taken using appropriate international
standard scale. Waist circumference were measured
using non stretchable tape, BMI was measured.
Statistical Analysis: Both descriptive and inferential
statistical analysis was carried out using SPSS.
Inferential statistics will include Independent T
test/Mann Whitney U Test, Paired sample T
test/Wilcoxon Signed Rank test, multiple regression
analysis/ Logistic regression, repeated measures
ANOVA, Chi-Square test of independence. Paired
sample t-test (two-tailed) or the repeated measures
ANOVA, whichever is appropriate. Equivalent non
parametric analysis was used in case of violations of
normality assumption.
Results: The prevalence of vitamin D insufficiency
and deficiency were determined for the obese and
non-overweight study population. Prevalence of
vitamin D deficiency was defined by three different
thresholds of 25(OH)D, severe, moderate deficiency,
deficiency and optimal level of vitamin D.
criteria of vitamin D status is as follows
(Povoroznyuk.V. 2013)
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Oct 2018 Page: 793
vitamin D metabolism were excluded from the
Those subjects having 25 (OH) vitamins D
ng/mL were also excluded from the study.
Institutional Review Board approved the projects.
Data was collected by
-validated questionnaire
developed by King Saud University, Biomarkers
Research Department after obtaining the consent from
the author of the questionnaire. Pre-validated
structured questionnaire was divided into three
Socio demographic data. b.
Polar questions with regard to knowledge about
Vitamin D and associated diseases. c. MCQ about
sunshine exposure and duration. 2. Measurement of
Serum analysis to find out the level of Vitamin D,
HSCRP and other biomarker values. The
recommended, best test for assessing vitamin D status
is to measure 25(OH) D levels using a reliable assay
in population at risk for vitamin D deficiency is
Electro chemical luminescence assay.
etric Assessment: Physical examination
was performed by the physician and the nurse. Height
and weight was taken using appropriate international
standard scale. Waist circumference were measured
using non stretchable tape, BMI was measured.
Both descriptive and inferential
statistical analysis was carried out using SPSS.
Inferential statistics will include Independent T
test/Mann Whitney U Test, Paired sample T
test/Wilcoxon Signed Rank test, multiple regression
ression, repeated measures
Square test of independence. Paired
tailed) or the repeated measures
ANOVA, whichever is appropriate. Equivalent non-
parametric analysis was used in case of violations of
The prevalence of vitamin D insufficiency
and deficiency were determined for the obese and
overweight study population. Prevalence of
vitamin D deficiency was defined by three different
thresholds of 25(OH)D, severe, moderate deficiency,
and optimal level of vitamin D. Diagnostic
criteria of vitamin D status is as follows [ 8 ]
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456
@ IJTSRD | Available Online @ www.ijtsrd.com
Vitamin D Severe deficiency
25(OH)D3
Concentration
0-10
A χ2 test was used to compare the prevalence rate of
vitamin D insufficiency and deficiency in the obese
group to the non-overweight group.
In the present study records of 124 ostensibly healthy
subjects enrolled for executive health check
different laboratories in India were chosen as research
Study subjects(124) % Mean
Male 77 18.96
Female 47 14.24
Total 124 -
This result is not significant at p < .05. The reviews of
(Babu& Calvo 2012) documents supports our research
findings of widespread vitamin D deficiency in Indian
populations in higher and lower socioeconomic strata,
in all age groups, in both genders and people in
various professions. The subjects with Vitamin D
deficiency were administered the recommended dose
of Vitamin D and found the significant outcome in
their serum level with the medianvalue of 31.28
(27.88–34.68) which was evident statistically by
Overall increase by 68% of 25(OH) vit
with no observed significant changes in the increased
level of vitamin D between male and female. Serum
25(OH) vitamin D decreased with increasing age in
all subjects (r = −0.29; P < 0.001).
Participants Moderate deficiency
Male 26(53%)
Female 23(47%)
Total 49
This result is not significant at p < .05.
Average 25(OH)D levels did not differ by gender among overweight, severe and moderate obesity or non
overweight group participants.Figure:1
Scientific Research and Development (IJTSRD) ISSN: 2456
www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018
Severe deficiency Deficiency Insufficiency Optimal level
10-20 20-30 30-80
test was used to compare the prevalence rate of
vitamin D insufficiency and deficiency in the obese
In the present study records of 124 ostensibly healthy
subjects enrolled for executive health check-up at
different laboratories in India were chosen as research
subjects. Amongst these, 77 % were male and 23
female. The mean 25(OH) vitamin D level in
population was found to be 17.37
(median 14.59) whereas upon segregation, in males
the mean level was 18.96 ±
17.76) and 14.24 ± 6.79 ng/mL (median 13.72) in
females (p < 0.0001).
Mean SD Severe Deficiency Optimal Level
18.96 10.36 18(51%) 5(55%)
14.24 6.79 17(49%) 4(45%)
- 35 9
.05. The reviews of
(Babu& Calvo 2012) documents supports our research
findings of widespread vitamin D deficiency in Indian
populations in higher and lower socioeconomic strata,
in all age groups, in both genders and people in
bjects with Vitamin D
deficiency were administered the recommended dose
of Vitamin D and found the significant outcome in
their serum level with the medianvalue of 31.28
34.68) which was evident statistically by
of 25(OH) vitamin D level
with no observed significant changes in the increased
level of vitamin D between male and female. Serum
25(OH) vitamin D decreased with increasing age in
On further evaluating these 124 subjects on the
of their 25(OH) vitamin D status, 53.69
to have 25(OH) vitamin D severe deficiency
(<12 ng/mL) which included 61
female. Similarly 25(OH) vitamin D moderate
insufficiency (<20ng/mL) was observed in about
39 % individuals including 52.5
female. Only 7.31 % of the total population had
optimal 25(OH) vitamin D levels (>30
included 96 % male and 4
25(OH) vitamin D level in the male severe vitamin D
deficiency group was 9.79±
significantly higher as compared to the female group
with 7.48 ± 1.77 ng/mL as mean value (
the moderate Vitamin D deficiency group, there was
no statistically significant difference between male
and female vitamin D level.
Moderate deficiency Severe deficiency Total Chi square
26(53%) 40(60.60%) 66
Not significant
23(47%) 26(39.40) 49
49 66 115
Average 25(OH)D levels did not differ by gender among overweight, severe and moderate obesity or non
Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Oct 2018 Page: 794
Optimal level Risk of Toxicity
>100
% were male and 23 %
female. The mean 25(OH) vitamin D level in the
population was found to be 17.37 ± 7.12 ng/mL
(median 14.59) whereas upon segregation, in males
± 10.36 ng/mL (median
6.79 ng/mL (median 13.72) in
Optimal Level Chi square
.048
Not significant
On further evaluating these 124 subjects on the basis
of their 25(OH) vitamin D status, 53.69 % were found
to have 25(OH) vitamin D severe deficiency
ng/mL) which included 61 % male and 39 %
female. Similarly 25(OH) vitamin D moderate
insufficiency (<20ng/mL) was observed in about
including 52.5 % male and 47.5 %
% of the total population had
optimal 25(OH) vitamin D levels (>30 ng/mL) which
% male and 4 % female. The mean
25(OH) vitamin D level in the male severe vitamin D
1.57 ng/mL which was
significantly higher as compared to the female group
ng/mL as mean value (p < 0.0001).In
the moderate Vitamin D deficiency group, there was
no statistically significant difference between male
Chi square
.654
Not significant
Average 25(OH)D levels did not differ by gender among overweight, severe and moderate obesity or non-
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456
@ IJTSRD | Available Online @ www.ijtsrd.com
The overall prevalence of obesity was 66.66%.
Among Subjects in optimal Vitamin D level it shows
a prevalence of 22.22% in Severe Obesity group,
hence severe obesity could be considered as an
associated factor for vitamin D deficiency. Our
research result supports the research finding of Rock
Cl et al 2012, involved data from 383 overweight or
obese women who participated in a 2
trial of a weight-loss program which showed that
those who did not lose weight at 24 months had an
increase in serum 25D of 1.9 ng/mL (4.8 nmol/L).
However, 25D increased by 2.7 ng/mL (6.8 nmol/L)
for those who lost 5%–10% of baseline weight, and
by 5.0 ng/mL (12.5 nmol/L) for those who lost >10%
of baseline weight (P = 0.014)Early, smaller studies
(Liely et al 1988) also reported an association
between obesity and low serum 25D concentrations,
as well as high concentrations of parathyroid hormone
(PTH) and 1,25-dihydroxyvitamin D (1,25D).
The overall participants CRP level ranged from .2 to
15.93mg/L with the Mean 5.15±2.98, where only
7.32% of the participants optimal level of CRP,
average risk participants were 24.39%(HSCRP level
between 1.0mg?L and 3mg/L), and the highest
percentage 68.29% of subjects (>3mg/L) were in high
risk group. The participants of obesity grou
high level of HSCRP with the Mean 7.07±SD .83,
however there is no statistical significant differences
among gender distribution of low level vitamin D,
HSCRP linked to severe obesity.
Two-way ANOVA was used to compare 25(OH) D
levels in the obese group to the non
group, compare seasonal levels, and assess the
interaction between obesity and season. Gender
patterns were also assessed with two-
models.
The interquartile ranges of 25(OH)D levels for
specified subgroups(severe vitamin D deficiency) is
Xl 5.75, Xu 8.51, Xu- Xl= 2.725.Box Whisker plot
Calculation: Minimum 4.2Maximum 10.23
First quartile 4.5Median 8.04Third quartile
13.5Ascending order 4.200.
Subjects were classified as low (L) if the serum level
of CRP was <1 mg/dL or as high (H) if the serum
level of CRP was ≥1 mg/dL. The detection sensitivity
of the assay was 0.1 mg/dL
Scientific Research and Development (IJTSRD) ISSN: 2456
www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018
The overall prevalence of obesity was 66.66%.
Among Subjects in optimal Vitamin D level it shows
a prevalence of 22.22% in Severe Obesity group,
hence severe obesity could be considered as an
associated factor for vitamin D deficiency. Our
supports the research finding of Rock
ata from 383 overweight or
obese women who participated in a 2-year clinical
loss program which showed that
those who did not lose weight at 24 months had an
25D of 1.9 ng/mL (4.8 nmol/L).
However, 25D increased by 2.7 ng/mL (6.8 nmol/L)
10% of baseline weight, and
by 5.0 ng/mL (12.5 nmol/L) for those who lost >10%
of baseline weight (P = 0.014)Early, smaller studies
so reported an association
between obesity and low serum 25D concentrations,
as well as high concentrations of parathyroid hormone
dihydroxyvitamin D (1,25D).
The overall participants CRP level ranged from .2 to
±2.98, where only
7.32% of the participants optimal level of CRP,
average risk participants were 24.39%(HSCRP level
between 1.0mg?L and 3mg/L), and the highest
percentage 68.29% of subjects (>3mg/L) were in high
risk group. The participants of obesity group had their
high level of HSCRP with the Mean 7.07±SD .83,
however there is no statistical significant differences
among gender distribution of low level vitamin D,
way ANOVA was used to compare 25(OH) D
bese group to the non-overweight
group, compare seasonal levels, and assess the
interaction between obesity and season. Gender
-way ANOVA
The interquartile ranges of 25(OH)D levels for
vitamin D deficiency) is
Box Whisker plot
4.2Maximum 10.23
First quartile 4.5Median 8.04Third quartile
Subjects were classified as low (L) if the serum level
g/dL or as high (H) if the serum
≥1 mg/dL. The detection sensitivity
Among participants 9.75% were only having normal
weight. Among 124 adults, 40.81% were overweight
and 34% were Obese. A prevalence of 15.44% am
the participants was found to be in Severe Obesity.
Study revealed with the great statistics of only 5.55%
were observed to be in low risk HSCRP, 11.11% of
average risk participants, and the higher proportion of
the subjects was in high risk group of 8
Average and High risk subjects were with the mean
value of 7.44(SD2.59).
In summary increased BMI was positively associated
with unfavorable biomarkers, such as LDL, HDL and
TG. Similar association between obesity and
biochemical markers has been s
populations worldwide. In
correlation co-efficient was
relationship between 25(OH)D and 2
HgbA1c, HSCRP. Data were adjusted for BMI Z
score and age. When data did not meet tests of
normality, data were log-
parametric tests were used. A of 0.05 was considered
significant for all statistical tests.
Discussion: Our study described the prevalence of
vitamin D deficiency and the associated link between
Obesity and HSCRP among Indian Adults at different
referral clinic. In our study the percent change in
hsCRP correlated similarly with changes in all
measures of body fat, and total abdominal,
subcutaneous abdominal, and visceral fat. We have
found high prevalence of vitamin D severe deficiency
53.69%, overweight 40.88%, obesity 66.66%, and
HSCRP. In addition obese adults are more likely to
present HSCRP with vitamin D deficiency and
undesirable biochemical markers values than Non
Obese. Only 9.5% of the study subject
having normal weight. Vitamin D status may be a
determining factor of systemic inflammation in
patients with T2DM. [ 9 ]
. In support of this notion we
found that the highest proportion of the subjects was
observed in high risk group of 83.33% in comparison
with their level of HSCRP, which is alarming sign of
leading them to potential cardiovascular risk factors.
The link between obesity and vitamin D deficiency
appears to be a one-way street. A large study of the
genetics underpinning both conditions finds that
obesity may drive down vitamin D levels, but a
predisposition to the vitamin deficiency doesn’t lead
to obesity. The findings also suggest that boosting
vitamin D levels won’t reverse
suggest that losing weight could potentially reverse
Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Oct 2018 Page: 795
Among participants 9.75% were only having normal
weight. Among 124 adults, 40.81% were overweight
. A prevalence of 15.44% among
found to be in Severe Obesity.
Study revealed with the great statistics of only 5.55%
were observed to be in low risk HSCRP, 11.11% of
average risk participants, and the higher proportion of
the subjects was in high risk group of 83.33%.
Average and High risk subjects were with the mean
In summary increased BMI was positively associated
with unfavorable biomarkers, such as LDL, HDL and
TG. Similar association between obesity and
biochemical markers has been showed in multiple
obese adult, Pearson
used to evaluate the
relationship between 25(OH)D and 2-h glucose,
HgbA1c, HSCRP. Data were adjusted for BMI Z
score and age. When data did not meet tests of
-transformed or non-
parametric tests were used. A of 0.05 was considered
significant for all statistical tests.
Our study described the prevalence of
vitamin D deficiency and the associated link between
HSCRP among Indian Adults at different
referral clinic. In our study the percent change in
hsCRP correlated similarly with changes in all
measures of body fat, and total abdominal,
subcutaneous abdominal, and visceral fat. We have
vitamin D severe deficiency
53.69%, overweight 40.88%, obesity 66.66%, and
HSCRP. In addition obese adults are more likely to
present HSCRP with vitamin D deficiency and
undesirable biochemical markers values than Non-
Obese. Only 9.5% of the study subjects found to be
having normal weight. Vitamin D status may be a
determining factor of systemic inflammation in
. In support of this notion we
highest proportion of the subjects was
high risk group of 83.33% in comparison
with their level of HSCRP, which is alarming sign of
leading them to potential cardiovascular risk factors.
The link between obesity and vitamin D deficiency
way street. A large study of the
etics underpinning both conditions finds that
obesity may drive down vitamin D levels, but a
predisposition to the vitamin deficiency doesn’t lead
to obesity. The findings also suggest that boosting
vitamin D levels won’t reverse obesity. The data
that losing weight could potentially reverse
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456
@ IJTSRD | Available Online @ www.ijtsrd.com
vitamin D deficiency in obese people, says Hyppönen.
Or, she says, obese people could improve their overall
health by having their vitamin D checked and
correcting any deficiency. Vitamin D is important for,
among other things, fighting infection, absorbing
calcium and maintaining a healthy immune system. In
summary overweight was positively associated with
low level vitamin D and High level SCRP. Low level
vitamin D is not significantly associated with
Overweight and HSCRP. Further to this our study
found the positive associated significant relationship
between Obesity and undesirable biomarker values.
Recommendation: Lifestyle intervention would bring
the adults the knowledge about the sources of vitamin
D for their better health to prevent them from
suffering with vitamin d deficiency related diseases
and complications in their lifetime. Prevention
supplements) is better than cure and management of
sources of acquiring and synthesizing VD is the key,
preventing Saudi adolescents from widespread bone
and other vitamin D deficiency disorder.
Conclusions: Vitamin D deficiency is common in
adults in this southern Indian region and is
significantly more prevalent in obese adults. Lower
25(OH) D level is associated with risk factors for type
2 diabetes in obese adults. This rise in obesity
prevalence has paralleled increases in adult
hypertension, hyperlipidemia, and type 2 diabetes
.Furthermore, epidemiological data have linked low
vitamin D levels to type 2 diabetes The mechanisms
by which obesity and its co morbidities
vitamin D deficiency are poorly understood. In
present study, we determined the prevalence of
vitamin D deficiency in adults referred to an obesity
and compared this prevalence to that of an age,
Obesity group and Non obese adults. We have also
examined associations between 25-hydro
[25(OH) vitamin D] and dietary habits in obese adults
and tested whether there were correlations between
25(OH) vitamin D and markers of lipid, renal and
insulin resistance.
Conflict of Interest:
The author declares no conflict of interest.
References:
1. Vimeswaran K., Berry D., Lu C., Pilz S., Hiraki
L., Cooper J., Dastani Z., Li R., Houston D.,
Wood A. Causal relationship between obesity and
vitamin D status: Bi-directional mendelian
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456
www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018
vitamin D deficiency in obese people, says Hyppönen.
Or, she says, obese people could improve their overall
health by having their vitamin D checked and
correcting any deficiency. Vitamin D is important for,
ng other things, fighting infection, absorbing
calcium and maintaining a healthy immune system. In
summary overweight was positively associated with
low level vitamin D and High level SCRP. Low level
vitamin D is not significantly associated with
t and HSCRP. Further to this our study
found the positive associated significant relationship
between Obesity and undesirable biomarker values.
intervention would bring
the adults the knowledge about the sources of vitamin
their better health to prevent them from
suffering with vitamin d deficiency related diseases
lifetime. Prevention (VD
supplements) is better than cure and management of
sources of acquiring and synthesizing VD is the key,
ting Saudi adolescents from widespread bone
and other vitamin D deficiency disorder.
D deficiency is common in
adults in this southern Indian region and is
significantly more prevalent in obese adults. Lower
25(OH) D level is associated with risk factors for type
rise in obesity
ncreases in adult
hypertension, hyperlipidemia, and type 2 diabetes
.Furthermore, epidemiological data have linked low
vitamin D levels to type 2 diabetes The mechanisms
co morbidities are related to
understood. In the
present study, we determined the prevalence of
vitamin D deficiency in adults referred to an obesity
and compared this prevalence to that of an age,
Obesity group and Non obese adults. We have also
hydroxyvitamin D
[25(OH) vitamin D] and dietary habits in obese adults
and tested whether there were correlations between
25(OH) vitamin D and markers of lipid, renal and
The author declares no conflict of interest.
Vimeswaran K., Berry D., Lu C., Pilz S., Hiraki
L., Cooper J., Dastani Z., Li R., Houston D.,
Wood A. Causal relationship between obesity and
directional mendelian
randomization analysis of multiple cohorts.
PLoS Med. 10:1549–1676
2. Walsh J S1, Bowles S, Evans A
obesity. Current Opinion in Endocrinology
Diabetes and Obesity. 2017. US National Library
of Medicine, National Institutes of Health,Volume
24(6), 389-394.
3. Kaptoge, S.; Angelantonio, E.; Pennells, L.;
Wood, A. M.; White, I. R.; Gao, P.; Walker, M.
Thompson, A.; Sarwar, N.; Caslake, M.;
reactive protein, fibrinogen, and cardiovascular
disease prediction. 2012. The New journal of
England Medicine. 4:367, P
4. Chen N, Wan Z, Han S F,
L Q, Effect of vitamin D supplementation on the
level of circulating high
protein: a meta-analysis of randomized controlled
trials. Nutrients, 2014.US National Library of
Medicine, National Institute of Health.10:6(6).
5. Simon Van lit, Obesity and Vitam
National Library of Medicine, MDPI, Nutrients,
Volume 5; (3) P; 949-956.
6. Vitamin D council 2015.
https://www.vitamindcouncil.org/2015
council-annual-report/.
7. Hussain A N, Alkhenizan A
H, Gabr A, (2014). Increasing trends and
significance of hypovitaminosis D: A population
based study in the kingdom of Saudi Arabia;
(9)190; e PubMed.
8. Pludowski P, karczmarewicz E, Bayer M, Carter
G, Chlebna-Sokol D, Czech
R, Decsi T, Dobrzanska A, Franek E, Gluszko P,
Grant WB, Holick MF, Yankovskaya L et al,
2013, US National Library of Medicine, National
Institutes of Health, Endokrynologia polska, 64:
(4), 319-27.
9. Fatemeh Haidari, Mehrnoosh Zakerkish, Majid
Karandish, Azadeh Saki, Sakineh Po
Association between serum vitamin D level and
Glycemic and Inflammatory markers in Non
Obese patients with Type 2 diabetes. Iran Journal
of Medical science, 41(5).
10. Erin S. LeBlanc, Joanne H.
Pedula, Kristine E. Ensrud, Jane C
Hochberg and Teresa A Hiller, 2012, Association
between 25- Hydroxyvitamin D and weight gain
in Elderly women, Journal of women's health,
21(10), 1066-1073.
International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470
Oct 2018 Page: 796
randomization analysis of multiple cohorts. 2013.
1676
Evans A L, Vitamin D in
Current Opinion in Endocrinology
2017. US National Library
of Medicine, National Institutes of Health,Volume
Kaptoge, S.; Angelantonio, E.; Pennells, L.;
R.; Gao, P.; Walker, M.;
Thompson, A.; Sarwar, N.; Caslake, M.; et al. C-
reactive protein, fibrinogen, and cardiovascular
2012. The New journal of
4:367, P-1310–1320.
Li B Y, Zhang Z L, Qin
amin D supplementation on the
level of circulating high-sensitivity C-reactive
analysis of randomized controlled
trials. Nutrients, 2014.US National Library of
Medicine, National Institute of Health.10:6(6).
Van lit, Obesity and Vitamin D, 2013. US
National Library of Medicine, MDPI, Nutrients,
956.
Vitamin D council 2015.
https://www.vitamindcouncil.org/2015-vitamin-d-
N, Alkhenizan A H, El Shaker M, Raef
A, (2014). Increasing trends and
significance of hypovitaminosis D: A population-
based study in the kingdom of Saudi Arabia;
Pludowski P, karczmarewicz E, Bayer M, Carter
Sokol D, Czech-Kowalska J, Debski
a A, Franek E, Gluszko P,
Grant WB, Holick MF, Yankovskaya L et al,
2013, US National Library of Medicine, National
Institutes of Health, Endokrynologia polska, 64:
Fatemeh Haidari, Mehrnoosh Zakerkish, Majid
Karandish, Azadeh Saki, Sakineh Pooraziz, 2016,
Association between serum vitamin D level and
Glycemic and Inflammatory markers in Non
Obese patients with Type 2 diabetes. Iran Journal
LeBlanc, Joanne H. Rizzo, Kathryn L
Ensrud, Jane Cauley, Marc
Hochberg and Teresa A Hiller, 2012, Association
Hydroxyvitamin D and weight gain
in Elderly women, Journal of women's health,

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Vitamin D Deficiency in Association with HSCRP Linked to Obesity

  • 1. International Journal of Trend in International Open Access Journal ISSN No: 2456 @ IJTSRD | Available Online @ www.ijtsrd.com Vitamin D Deficiency in Association w Dr. Pushpamala Dr. Lamiaa Ahmed Elsayed 1,4 Professor, 2 Associate P 3 Associate 1,2,3,4 Umm al Qura University, Makkah, Kingdom of Saudi Arabia ABSTRACT Vitamin D deficiency is gaining increasing attention for its novel association with Obesity. Studies have found that maintaining vitamin D status may reduce ones risk of developing various diseases. Background In 2010, overweight and obesity were estimated cause 3•4 million deaths, 3•9% of years of life lost, and 3•8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all population treatment of obesity and cardiovascular diseases is one of the most difficult and important challenges nowadays. This paper seeks to examine the consistently reported relationship between obesity and low vitamin D concentrations in association with HSCRP, with reference to the possible underlying mechanisms. The possibility that vitamin D may assist in preventing or treating obesity is also examined and recommendations for future research are made. We tested the hypothesis that suggests Adults with s obesity have lower 25-hydroxyvitamin D levels will have higher hs-CRP levels. Keyword: Vitamin D deficiency, High Sensitive C Reactive Protein, Obesity. INTRODUCTION Vitamin D deficiency is the most common nutritional deficiency and the very likely, the most common medical condition in the world. There is a consistent association in the published literature between increasing BMI and lower serum 25-hydroxyvitamin D (25D) concentrations. A bi-directional genetic study, which limits confounding, has suggested that higher BMI leads to lower 25D, with the effects of lower 25D on BMI likely to be small International Journal of Trend in Scientific Research and Development (IJTSRD) International Open Access Journal | www.ijtsrd.com ISSN No: 2456 - 6470 | Volume - 2 | Issue – 6 | Sep www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018 Deficiency in Association with HSCRP Linked t Pushpamala Ramaiah1 , Dr. Ayman Johargy2 , Lamiaa Ahmed Elsayed3 , Dr. Grace Lindsey4 Professor of Medical Microbiology, Faculty of Medicine Associate Professor at Faculty of Nursing Umm al Qura University, Makkah, Kingdom of Saudi Arabia Vitamin D deficiency is gaining increasing attention for its novel association with Obesity. Studies have found that maintaining vitamin D status may reduce ones risk of developing various diseases. Background In 2010, overweight and obesity were estimated to cause 3•4 million deaths, 3•9% of years of life lost, years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. The treatment of obesity and cardiovascular diseases is one of the most difficult and important challenges nowadays. This paper seeks to examine the consistently reported relationship between obesity and low vitamin D concentrations in association with HSCRP, with reference to the possible underlying mechanisms. The possibility that vitamin D may assist in preventing or treating obesity is also examined and recommendations for future research are made. We tested the hypothesis that suggests Adults with severe hydroxyvitamin D levels will Vitamin D deficiency, High Sensitive C Vitamin D deficiency is the most common nutritional likely, the most common medical condition in the world. There is a consistent association in the published literature between hydroxyvitamin directional genetic has suggested that higher BMI leads to lower 25D, with the effects of lower 25D on BMI likely to be small[1] . Lower vitamin D in obese people is a consistent finding across age, ethnicity, and geography. This may not always reflect a clinical problem. higher loading doses of vitamin D to achieve the same serum 25-hydroxyvitamin D as normal weight. His work suggests that vitamin D gets diluted throughout the body, and that dilution shows up as a deficiency in overweight and obese more mass than normal-weight people. On the other hand, a number of studies have confirmed that C reactive protein (CRP), an inflammatory marker, is a strong predictor of CVD Thus, it is likely feasible to prevent CVD with the help of CRP treatments.[ 3 ] . Previous studies have shown that vitamin D deficiency is associated with both developing obesity and the risk of obesity related complications, but studies on the effects of vitamin D supplementation have been inconclusive. The association between reduced 25D concentrations and obesity is therefore well-established, although the mechanisms for the lower 25D concentrations are not fully described, and there is uncertainty as to what the health consequences of these lower concentrations might be. This paper attempts to summarize the current state of knowledge regarding the causes of these reduced 25D concentrations, as well as the possible effects of vitamin D supplementation on obesity. [4] Background: It has been estimated that 1 billion people worldwide have Vitamin D deficiency or insufficiency. This is mostly attributable to people getting less sun exposure because of climate, and concerns about skin cancer. association in the published literature between increasing BMI and lower serum 25 Research and Development (IJTSRD) www.ijtsrd.com 6 | Sep – Oct 2018 Oct 2018 Page: 792 Linked to Obesity of Medical Microbiology, Faculty of Medicine, Umm al Qura University, Makkah, Kingdom of Saudi Arabia vitamin D in obese people is a consistent finding across age, ethnicity, and geography. This may not always reflect a clinical problem. Obese people need higher loading doses of vitamin D to achieve the same hydroxyvitamin D as normal weight. [ 2 ] . His work suggests that vitamin D gets diluted throughout the body, and that dilution shows up as a deficiency in overweight and obese people, who have weight people. On the other hand, a number of studies have confirmed that C- reactive protein (CRP), an inflammatory marker, is a strong predictor of CVD Thus, it is likely feasible to prevent CVD with the help of CRP-reducing Previous studies have shown deficiency is associated with both developing obesity and the risk of obesity related omplications, but studies on the effects of vitamin D supplementation have been inconclusive. The association between reduced 25D concentrations and established, although the mechanisms for the lower 25D concentrations are not ly described, and there is uncertainty as to what the health consequences of these lower concentrations might be. This paper attempts to summarize the current state of knowledge regarding the causes of these reduced 25D concentrations, as well as the ble effects of vitamin D supplementation on It has been estimated that 1 billion people worldwide have Vitamin D deficiency or insufficiency. This is mostly attributable to people getting less sun exposure because of climate, lifestyle, and concerns about skin cancer. There is a consistent association in the published literature between increasing BMI and lower serum 25-hydroxyvitamin
  • 2. International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 @ IJTSRD | Available Online @ www.ijtsrd.com D (25D) concentrations.[5] . Some people get tested for vitamin D and find, despite taking vita regularly, that they are still not getting enough vitamin D. This means their body is having hard time absorbing their vitamin D supplements. The vitamin D council recommends testing every three to six months, if they are trying different regimens. T vitamin D council believes that trying to get enough vitamin D from diet is unlikely to get sufficient vitamin D which is needed. [6] .Recently, there has been increased interest in the relevance for vitamin D to human health accompanied by increase dema vitamin D testing, which has led to the use of less precise assays, which recommend the use of gold standard LC-MS assay, and insist a large national community based study of the prevalence of low vitamin D using this method. [7] . Al-Daggrey (2014) pointed out that the recommended period for sun exposure to the sun is half-an-hour, three to four days a week. There is a clear need for adequately prospective interventions which include baseline measurement of 25D concentrations and CRP also involve adequate doses of supplemental vitamin D. Until such studies have been reported, the role of vitamin D supplementation in obesity prevention remains uncertain. The aim of the study was:  To identify the prevalence of vitamin D deficiency and HSCRP among adults.  To examine relationships between dietary habits and 25-hydroxyvitamin D [25(OH)D] level.  Investigate the associations between the 25(OH)D concentrations and the biomarker of i HSCRP.  To evaluate whether vitamin D insufficiency and increased serum high-sensitivity C protein (hs-CRP) linked to Obesity. Patients and Methods: Using a longitudinal, cross sectional design, systolic and diastolic blood pressure, dietary information, serum 25(OH) D, serum CRP, fasting glucose and insulin, 2-h glucose from oral glucose tolerance test, hemoglobin A1c, thyroid profile, liver profile were recorded for 124 volunteer subjects at an referral clinic. Data was collected during their visit at clinic between April 2017 and April 2018. Adults of ages between 20 to 65 years were selected as participants, written informed consent was obtained from the subjects from whom data were collected prospectively. The subjects who were on use of any medication known to effect International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018 Some people get tested for vitamin D and find, despite taking vitamin D regularly, that they are still not getting enough vitamin D. This means their body is having hard time absorbing their vitamin D supplements. The vitamin D council recommends testing every three to six months, if they are trying different regimens. The vitamin D council believes that trying to get enough vitamin D from diet is unlikely to get sufficient .Recently, there has been increased interest in the relevance for vitamin D to human health accompanied by increase demand of vitamin D testing, which has led to the use of less precise assays, which recommend the use of gold MS assay, and insist a large national community based study of the prevalence of low Daggrey (2014) ointed out that the recommended period for sun hour, three to four days There is a clear need for adequately-powered, prospective interventions which include baseline measurement of 25D concentrations and CRP also olve adequate doses of supplemental vitamin D. Until such studies have been reported, the role of vitamin D supplementation in obesity prevention To identify the prevalence of vitamin D deficiency To examine relationships between dietary habits hydroxyvitamin D [25(OH)D] level. Investigate the associations between the 25(OH)D concentrations and the biomarker of inflammation To evaluate whether vitamin D insufficiency and sensitivity C-reactive Using a longitudinal, cross- sectional design, systolic and diastolic blood pressure, ietary information, serum 25(OH) D, serum CRP, h glucose from oral glucose tolerance test, hemoglobin A1c, thyroid profile, liver profile were recorded for 124 volunteer subjects at an referral clinic. Data was collected ng their visit at clinic between April 2017 and April 2018. Adults of ages between 20 to 65 years were selected as participants, written informed consent was obtained from the subjects from whom data were collected prospectively. The subjects who se of any medication known to effect vitamin D metabolism were excluded from the project. Those subjects having 25 (OH) vitamins D level > 150 ng/mL were also excluded from the study. Institutional Review Board approved the projects. Tools of data collection: Data was collected by using: 1. A structured pre- developed by King Saud University, Biomarkers Research Department after obtaining the consent from the author of the questionnaire. Pre structured questionnaire was div sections as follows: a. Socio demographic data. Polar questions with regard to knowledge about Vitamin D and associated diseases. sunshine exposure and duration. Serum analysis to find out the level of HSCRP and other biomarker values. The recommended, best test for assessing vitamin D status is to measure 25(OH) D levels using a reliable assay in population at risk for vitamin D deficiency is Electro chemical luminescence assay. 3. Anthropometric Assessment: was performed by the physician and the nurse. Height and weight was taken using appropriate international standard scale. Waist circumference were measured using non stretchable tape, BMI was measured. Statistical Analysis: Both descriptive and inferential statistical analysis was carried out using SPSS. Inferential statistics will include Independent T test/Mann Whitney U Test, Paired sample T test/Wilcoxon Signed Rank test, multiple regression analysis/ Logistic regression, repeated measures ANOVA, Chi-Square test of independence. Paired sample t-test (two-tailed) or the repeated measures ANOVA, whichever is appropriate. Equivalent non parametric analysis was used in case of violations of normality assumption. Results: The prevalence of vitamin D insufficiency and deficiency were determined for the obese and non-overweight study population. Prevalence of vitamin D deficiency was defined by three different thresholds of 25(OH)D, severe, moderate deficiency, deficiency and optimal level of vitamin D. criteria of vitamin D status is as follows (Povoroznyuk.V. 2013) International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456-6470 Oct 2018 Page: 793 vitamin D metabolism were excluded from the Those subjects having 25 (OH) vitamins D ng/mL were also excluded from the study. Institutional Review Board approved the projects. Data was collected by -validated questionnaire developed by King Saud University, Biomarkers Research Department after obtaining the consent from the author of the questionnaire. Pre-validated structured questionnaire was divided into three Socio demographic data. b. Polar questions with regard to knowledge about Vitamin D and associated diseases. c. MCQ about sunshine exposure and duration. 2. Measurement of Serum analysis to find out the level of Vitamin D, HSCRP and other biomarker values. The recommended, best test for assessing vitamin D status is to measure 25(OH) D levels using a reliable assay in population at risk for vitamin D deficiency is Electro chemical luminescence assay. etric Assessment: Physical examination was performed by the physician and the nurse. Height and weight was taken using appropriate international standard scale. Waist circumference were measured using non stretchable tape, BMI was measured. Both descriptive and inferential statistical analysis was carried out using SPSS. Inferential statistics will include Independent T test/Mann Whitney U Test, Paired sample T test/Wilcoxon Signed Rank test, multiple regression ression, repeated measures Square test of independence. Paired tailed) or the repeated measures ANOVA, whichever is appropriate. Equivalent non- parametric analysis was used in case of violations of The prevalence of vitamin D insufficiency and deficiency were determined for the obese and overweight study population. Prevalence of vitamin D deficiency was defined by three different thresholds of 25(OH)D, severe, moderate deficiency, and optimal level of vitamin D. Diagnostic criteria of vitamin D status is as follows [ 8 ]
  • 3. International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 @ IJTSRD | Available Online @ www.ijtsrd.com Vitamin D Severe deficiency 25(OH)D3 Concentration 0-10 A χ2 test was used to compare the prevalence rate of vitamin D insufficiency and deficiency in the obese group to the non-overweight group. In the present study records of 124 ostensibly healthy subjects enrolled for executive health check different laboratories in India were chosen as research Study subjects(124) % Mean Male 77 18.96 Female 47 14.24 Total 124 - This result is not significant at p < .05. The reviews of (Babu& Calvo 2012) documents supports our research findings of widespread vitamin D deficiency in Indian populations in higher and lower socioeconomic strata, in all age groups, in both genders and people in various professions. The subjects with Vitamin D deficiency were administered the recommended dose of Vitamin D and found the significant outcome in their serum level with the medianvalue of 31.28 (27.88–34.68) which was evident statistically by Overall increase by 68% of 25(OH) vit with no observed significant changes in the increased level of vitamin D between male and female. Serum 25(OH) vitamin D decreased with increasing age in all subjects (r = −0.29; P < 0.001). Participants Moderate deficiency Male 26(53%) Female 23(47%) Total 49 This result is not significant at p < .05. Average 25(OH)D levels did not differ by gender among overweight, severe and moderate obesity or non overweight group participants.Figure:1 Scientific Research and Development (IJTSRD) ISSN: 2456 www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018 Severe deficiency Deficiency Insufficiency Optimal level 10-20 20-30 30-80 test was used to compare the prevalence rate of vitamin D insufficiency and deficiency in the obese In the present study records of 124 ostensibly healthy subjects enrolled for executive health check-up at different laboratories in India were chosen as research subjects. Amongst these, 77 % were male and 23 female. The mean 25(OH) vitamin D level in population was found to be 17.37 (median 14.59) whereas upon segregation, in males the mean level was 18.96 ± 17.76) and 14.24 ± 6.79 ng/mL (median 13.72) in females (p < 0.0001). Mean SD Severe Deficiency Optimal Level 18.96 10.36 18(51%) 5(55%) 14.24 6.79 17(49%) 4(45%) - 35 9 .05. The reviews of (Babu& Calvo 2012) documents supports our research findings of widespread vitamin D deficiency in Indian populations in higher and lower socioeconomic strata, in all age groups, in both genders and people in bjects with Vitamin D deficiency were administered the recommended dose of Vitamin D and found the significant outcome in their serum level with the medianvalue of 31.28 34.68) which was evident statistically by of 25(OH) vitamin D level with no observed significant changes in the increased level of vitamin D between male and female. Serum 25(OH) vitamin D decreased with increasing age in On further evaluating these 124 subjects on the of their 25(OH) vitamin D status, 53.69 to have 25(OH) vitamin D severe deficiency (<12 ng/mL) which included 61 female. Similarly 25(OH) vitamin D moderate insufficiency (<20ng/mL) was observed in about 39 % individuals including 52.5 female. Only 7.31 % of the total population had optimal 25(OH) vitamin D levels (>30 included 96 % male and 4 25(OH) vitamin D level in the male severe vitamin D deficiency group was 9.79± significantly higher as compared to the female group with 7.48 ± 1.77 ng/mL as mean value ( the moderate Vitamin D deficiency group, there was no statistically significant difference between male and female vitamin D level. Moderate deficiency Severe deficiency Total Chi square 26(53%) 40(60.60%) 66 Not significant 23(47%) 26(39.40) 49 49 66 115 Average 25(OH)D levels did not differ by gender among overweight, severe and moderate obesity or non Scientific Research and Development (IJTSRD) ISSN: 2456-6470 Oct 2018 Page: 794 Optimal level Risk of Toxicity >100 % were male and 23 % female. The mean 25(OH) vitamin D level in the population was found to be 17.37 ± 7.12 ng/mL (median 14.59) whereas upon segregation, in males ± 10.36 ng/mL (median 6.79 ng/mL (median 13.72) in Optimal Level Chi square .048 Not significant On further evaluating these 124 subjects on the basis of their 25(OH) vitamin D status, 53.69 % were found to have 25(OH) vitamin D severe deficiency ng/mL) which included 61 % male and 39 % female. Similarly 25(OH) vitamin D moderate insufficiency (<20ng/mL) was observed in about including 52.5 % male and 47.5 % % of the total population had optimal 25(OH) vitamin D levels (>30 ng/mL) which % male and 4 % female. The mean 25(OH) vitamin D level in the male severe vitamin D 1.57 ng/mL which was significantly higher as compared to the female group ng/mL as mean value (p < 0.0001).In the moderate Vitamin D deficiency group, there was no statistically significant difference between male Chi square .654 Not significant Average 25(OH)D levels did not differ by gender among overweight, severe and moderate obesity or non-
  • 4. International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 @ IJTSRD | Available Online @ www.ijtsrd.com The overall prevalence of obesity was 66.66%. Among Subjects in optimal Vitamin D level it shows a prevalence of 22.22% in Severe Obesity group, hence severe obesity could be considered as an associated factor for vitamin D deficiency. Our research result supports the research finding of Rock Cl et al 2012, involved data from 383 overweight or obese women who participated in a 2 trial of a weight-loss program which showed that those who did not lose weight at 24 months had an increase in serum 25D of 1.9 ng/mL (4.8 nmol/L). However, 25D increased by 2.7 ng/mL (6.8 nmol/L) for those who lost 5%–10% of baseline weight, and by 5.0 ng/mL (12.5 nmol/L) for those who lost >10% of baseline weight (P = 0.014)Early, smaller studies (Liely et al 1988) also reported an association between obesity and low serum 25D concentrations, as well as high concentrations of parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,25D). The overall participants CRP level ranged from .2 to 15.93mg/L with the Mean 5.15±2.98, where only 7.32% of the participants optimal level of CRP, average risk participants were 24.39%(HSCRP level between 1.0mg?L and 3mg/L), and the highest percentage 68.29% of subjects (>3mg/L) were in high risk group. The participants of obesity grou high level of HSCRP with the Mean 7.07±SD .83, however there is no statistical significant differences among gender distribution of low level vitamin D, HSCRP linked to severe obesity. Two-way ANOVA was used to compare 25(OH) D levels in the obese group to the non group, compare seasonal levels, and assess the interaction between obesity and season. Gender patterns were also assessed with two- models. The interquartile ranges of 25(OH)D levels for specified subgroups(severe vitamin D deficiency) is Xl 5.75, Xu 8.51, Xu- Xl= 2.725.Box Whisker plot Calculation: Minimum 4.2Maximum 10.23 First quartile 4.5Median 8.04Third quartile 13.5Ascending order 4.200. Subjects were classified as low (L) if the serum level of CRP was <1 mg/dL or as high (H) if the serum level of CRP was ≥1 mg/dL. The detection sensitivity of the assay was 0.1 mg/dL Scientific Research and Development (IJTSRD) ISSN: 2456 www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018 The overall prevalence of obesity was 66.66%. Among Subjects in optimal Vitamin D level it shows a prevalence of 22.22% in Severe Obesity group, hence severe obesity could be considered as an associated factor for vitamin D deficiency. Our supports the research finding of Rock ata from 383 overweight or obese women who participated in a 2-year clinical loss program which showed that those who did not lose weight at 24 months had an 25D of 1.9 ng/mL (4.8 nmol/L). However, 25D increased by 2.7 ng/mL (6.8 nmol/L) 10% of baseline weight, and by 5.0 ng/mL (12.5 nmol/L) for those who lost >10% of baseline weight (P = 0.014)Early, smaller studies so reported an association between obesity and low serum 25D concentrations, as well as high concentrations of parathyroid hormone dihydroxyvitamin D (1,25D). The overall participants CRP level ranged from .2 to ±2.98, where only 7.32% of the participants optimal level of CRP, average risk participants were 24.39%(HSCRP level between 1.0mg?L and 3mg/L), and the highest percentage 68.29% of subjects (>3mg/L) were in high risk group. The participants of obesity group had their high level of HSCRP with the Mean 7.07±SD .83, however there is no statistical significant differences among gender distribution of low level vitamin D, way ANOVA was used to compare 25(OH) D bese group to the non-overweight group, compare seasonal levels, and assess the interaction between obesity and season. Gender -way ANOVA The interquartile ranges of 25(OH)D levels for vitamin D deficiency) is Box Whisker plot 4.2Maximum 10.23 First quartile 4.5Median 8.04Third quartile Subjects were classified as low (L) if the serum level g/dL or as high (H) if the serum ≥1 mg/dL. The detection sensitivity Among participants 9.75% were only having normal weight. Among 124 adults, 40.81% were overweight and 34% were Obese. A prevalence of 15.44% am the participants was found to be in Severe Obesity. Study revealed with the great statistics of only 5.55% were observed to be in low risk HSCRP, 11.11% of average risk participants, and the higher proportion of the subjects was in high risk group of 8 Average and High risk subjects were with the mean value of 7.44(SD2.59). In summary increased BMI was positively associated with unfavorable biomarkers, such as LDL, HDL and TG. Similar association between obesity and biochemical markers has been s populations worldwide. In correlation co-efficient was relationship between 25(OH)D and 2 HgbA1c, HSCRP. Data were adjusted for BMI Z score and age. When data did not meet tests of normality, data were log- parametric tests were used. A of 0.05 was considered significant for all statistical tests. Discussion: Our study described the prevalence of vitamin D deficiency and the associated link between Obesity and HSCRP among Indian Adults at different referral clinic. In our study the percent change in hsCRP correlated similarly with changes in all measures of body fat, and total abdominal, subcutaneous abdominal, and visceral fat. We have found high prevalence of vitamin D severe deficiency 53.69%, overweight 40.88%, obesity 66.66%, and HSCRP. In addition obese adults are more likely to present HSCRP with vitamin D deficiency and undesirable biochemical markers values than Non Obese. Only 9.5% of the study subject having normal weight. Vitamin D status may be a determining factor of systemic inflammation in patients with T2DM. [ 9 ] . In support of this notion we found that the highest proportion of the subjects was observed in high risk group of 83.33% in comparison with their level of HSCRP, which is alarming sign of leading them to potential cardiovascular risk factors. The link between obesity and vitamin D deficiency appears to be a one-way street. A large study of the genetics underpinning both conditions finds that obesity may drive down vitamin D levels, but a predisposition to the vitamin deficiency doesn’t lead to obesity. The findings also suggest that boosting vitamin D levels won’t reverse suggest that losing weight could potentially reverse Scientific Research and Development (IJTSRD) ISSN: 2456-6470 Oct 2018 Page: 795 Among participants 9.75% were only having normal weight. Among 124 adults, 40.81% were overweight . A prevalence of 15.44% among found to be in Severe Obesity. Study revealed with the great statistics of only 5.55% were observed to be in low risk HSCRP, 11.11% of average risk participants, and the higher proportion of the subjects was in high risk group of 83.33%. Average and High risk subjects were with the mean In summary increased BMI was positively associated with unfavorable biomarkers, such as LDL, HDL and TG. Similar association between obesity and biochemical markers has been showed in multiple obese adult, Pearson used to evaluate the relationship between 25(OH)D and 2-h glucose, HgbA1c, HSCRP. Data were adjusted for BMI Z score and age. When data did not meet tests of -transformed or non- parametric tests were used. A of 0.05 was considered significant for all statistical tests. Our study described the prevalence of vitamin D deficiency and the associated link between HSCRP among Indian Adults at different referral clinic. In our study the percent change in hsCRP correlated similarly with changes in all measures of body fat, and total abdominal, subcutaneous abdominal, and visceral fat. We have vitamin D severe deficiency 53.69%, overweight 40.88%, obesity 66.66%, and HSCRP. In addition obese adults are more likely to present HSCRP with vitamin D deficiency and undesirable biochemical markers values than Non- Obese. Only 9.5% of the study subjects found to be having normal weight. Vitamin D status may be a determining factor of systemic inflammation in . In support of this notion we highest proportion of the subjects was high risk group of 83.33% in comparison with their level of HSCRP, which is alarming sign of leading them to potential cardiovascular risk factors. The link between obesity and vitamin D deficiency way street. A large study of the etics underpinning both conditions finds that obesity may drive down vitamin D levels, but a predisposition to the vitamin deficiency doesn’t lead to obesity. The findings also suggest that boosting vitamin D levels won’t reverse obesity. The data that losing weight could potentially reverse
  • 5. International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 @ IJTSRD | Available Online @ www.ijtsrd.com vitamin D deficiency in obese people, says Hyppönen. Or, she says, obese people could improve their overall health by having their vitamin D checked and correcting any deficiency. Vitamin D is important for, among other things, fighting infection, absorbing calcium and maintaining a healthy immune system. In summary overweight was positively associated with low level vitamin D and High level SCRP. Low level vitamin D is not significantly associated with Overweight and HSCRP. Further to this our study found the positive associated significant relationship between Obesity and undesirable biomarker values. Recommendation: Lifestyle intervention would bring the adults the knowledge about the sources of vitamin D for their better health to prevent them from suffering with vitamin d deficiency related diseases and complications in their lifetime. Prevention supplements) is better than cure and management of sources of acquiring and synthesizing VD is the key, preventing Saudi adolescents from widespread bone and other vitamin D deficiency disorder. Conclusions: Vitamin D deficiency is common in adults in this southern Indian region and is significantly more prevalent in obese adults. Lower 25(OH) D level is associated with risk factors for type 2 diabetes in obese adults. This rise in obesity prevalence has paralleled increases in adult hypertension, hyperlipidemia, and type 2 diabetes .Furthermore, epidemiological data have linked low vitamin D levels to type 2 diabetes The mechanisms by which obesity and its co morbidities vitamin D deficiency are poorly understood. In present study, we determined the prevalence of vitamin D deficiency in adults referred to an obesity and compared this prevalence to that of an age, Obesity group and Non obese adults. We have also examined associations between 25-hydro [25(OH) vitamin D] and dietary habits in obese adults and tested whether there were correlations between 25(OH) vitamin D and markers of lipid, renal and insulin resistance. Conflict of Interest: The author declares no conflict of interest. References: 1. Vimeswaran K., Berry D., Lu C., Pilz S., Hiraki L., Cooper J., Dastani Z., Li R., Houston D., Wood A. Causal relationship between obesity and vitamin D status: Bi-directional mendelian International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 www.ijtsrd.com | Volume – 2 | Issue – 6 | Sep-Oct 2018 vitamin D deficiency in obese people, says Hyppönen. Or, she says, obese people could improve their overall health by having their vitamin D checked and correcting any deficiency. Vitamin D is important for, ng other things, fighting infection, absorbing calcium and maintaining a healthy immune system. In summary overweight was positively associated with low level vitamin D and High level SCRP. Low level vitamin D is not significantly associated with t and HSCRP. Further to this our study found the positive associated significant relationship between Obesity and undesirable biomarker values. intervention would bring the adults the knowledge about the sources of vitamin their better health to prevent them from suffering with vitamin d deficiency related diseases lifetime. Prevention (VD supplements) is better than cure and management of sources of acquiring and synthesizing VD is the key, ting Saudi adolescents from widespread bone and other vitamin D deficiency disorder. D deficiency is common in adults in this southern Indian region and is significantly more prevalent in obese adults. Lower 25(OH) D level is associated with risk factors for type rise in obesity ncreases in adult hypertension, hyperlipidemia, and type 2 diabetes .Furthermore, epidemiological data have linked low vitamin D levels to type 2 diabetes The mechanisms co morbidities are related to understood. In the present study, we determined the prevalence of vitamin D deficiency in adults referred to an obesity and compared this prevalence to that of an age, Obesity group and Non obese adults. We have also hydroxyvitamin D [25(OH) vitamin D] and dietary habits in obese adults and tested whether there were correlations between 25(OH) vitamin D and markers of lipid, renal and The author declares no conflict of interest. Vimeswaran K., Berry D., Lu C., Pilz S., Hiraki L., Cooper J., Dastani Z., Li R., Houston D., Wood A. Causal relationship between obesity and directional mendelian randomization analysis of multiple cohorts. PLoS Med. 10:1549–1676 2. Walsh J S1, Bowles S, Evans A obesity. 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Increasing trends and significance of hypovitaminosis D: A population based study in the kingdom of Saudi Arabia; (9)190; e PubMed. 8. Pludowski P, karczmarewicz E, Bayer M, Carter G, Chlebna-Sokol D, Czech R, Decsi T, Dobrzanska A, Franek E, Gluszko P, Grant WB, Holick MF, Yankovskaya L et al, 2013, US National Library of Medicine, National Institutes of Health, Endokrynologia polska, 64: (4), 319-27. 9. Fatemeh Haidari, Mehrnoosh Zakerkish, Majid Karandish, Azadeh Saki, Sakineh Po Association between serum vitamin D level and Glycemic and Inflammatory markers in Non Obese patients with Type 2 diabetes. Iran Journal of Medical science, 41(5). 10. Erin S. LeBlanc, Joanne H. Pedula, Kristine E. Ensrud, Jane C Hochberg and Teresa A Hiller, 2012, Association between 25- Hydroxyvitamin D and weight gain in Elderly women, Journal of women's health, 21(10), 1066-1073. 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